AN ACT TO AMEND TITLE 18 OF THE DELAWARE CODE RELATING TO HEALTH INSURANCE CONTRACTS.

Synopsis of Orginal Bill:(without Amendments)

This bill is designed to bring the health insurance provisions of the Delaware Insurance Code in compliance with the Patient Protection and Affordable Care Act (“PPACA”).
Sections 1, 2, 3, 6, 7, 10, and 14 (in part) of this bill amend the Delaware Insurance Code to reflect the requirement that dependents be covered up until the age of 26.
Sections 5, 9, 11, and 15 of this bill amend the Delaware Insurance Code to reflect the requirement that coverage not be denied due to preexisting conditions.
Section 4 of this bill adds a new provision to the Delaware Insurance Code for individual health insurance policies that (i) prohibits insurance companies from imposing lifetime and annual limits on essential health benefits for policies that have policy years beginning on or after January 1, 2014, and (ii) for policies that have policy years beginning prior to January 1, 2014, sets the minimum limits insurance companies may impose for essential health benefits.
Section 8 of this bill adds several new provisions to Chapter 35 of the Delaware Insurance Code (relating to group and blanket health insurance policies), specifically including provisions that: (i)(A) prohibit insurance companies from imposing lifetime and annual limits on essential health benefits for policies that have policy years beginning on or after January 1, 2014, and (B) for policies that have policy years beginning prior to January 1, 2014, set the minimum limits insurance companies may impose for essential health benefits; (ii) require guaranteed availability of coverage and set forth the enrollment period and network plan requirements; (iii) prohibit excessive waiting periods; (iv) prohibit discrimination against health care providers; (v) require health insurance companies to ensure that (A) plans offered cover all essential health benefits, (B) annual cost-sharing provisions do not exceed the limitations imposed by PPACA and (C) the health insurance companies offer child-only plans; (vi) prohibit discrimination against participants and beneficiaries based on health status and provide the requirements for health promotion and disease prevention programs; and (vii) discuss the certification requirements for participation in the State health exchange program.
Section 12 of this bill deletes the current provision in the Delaware Insurance Code regarding limited guarantee issue of insurance policies and adds a new provision relating to individual health insurance policies that requires guaranteed availability of coverage and sets forth the enrollment period and network plan requirements.
Section 13 of this bill adds several new provisions to Chapter 36 of the Delaware Insurance Code (relating to individual health insurance policies), specifically including provisions that: (i) prohibit excessive waiting periods; (ii) prohibit discrimination against health care providers; (iii) require health insurance companies to ensure that (A) coverage offered covers all essential health benefits, (B) annual cost-sharing provisions do not exceed the limitations imposed by PPACA and (C) the health insurance companies offer child-only plans; (iv) prohibit discrimination against participants and beneficiaries based on health status; and (v) discuss the certification requirements for participation in the State health exchange program.
The remaining amendments set forth in Section 14 of this bill (relating to Section 7202(16) and (34)) amend the definitions of “eligible employee” and “small employer” to conform to the federal definition, which dictates that sole proprietors and their family members are not “eligible employees” for purposes of acquiring a small group insurance policy.
Section 16 of this bill relates to the Mini-COBRA small employer group health policies provision, 28 Del. Laws, c. 246 (the “Mini-COBRA Bill”). The Mini-COBRA Bill was originally passed as a short-term bill that was needed until the provisions of the Patient Protection and Affordable Care Act (“PPACA”) became applicable to states, which was to occur on January 1, 2014. However, because PPACA’s legislation relating to small employer group health policies now permits insurance companies to impose a ninety (90) day waiting period prior to the effective date of coverage, which was not anticipated when the Mini-COBRA Bill was passed, it is desirable to remove the sunset provision of the Mini-COBRA Bill so that the Mini-COBRA Bill remains in the Delaware Code, at least until a point in time when PPACA or other law may no longer permit an insurance company to impose waiting periods.